全球领导人营养不良倡议(GLIM)标准及其推广应用

GLIM CRITERIA AND ITS POPULARIZATION AND APPLICATION

营养不良的诊断标准一直是困扰医学界的难题,究其原因主要是营养不良的定义不明确。2015年ESPEN发表专家共识,将营养不良定义为能量及宏量营养素不足,即蛋白-能量营养不良(protein-energy malnutrition,PEM)。该定义为建立新的营养不良诊断标准开辟了空间。全球领导人营养不良倡议(Global Leadership Initiative on Malnutrition,GLIM)就是这个条件下的产物。2016年美国肠外肠内营养学会、欧洲肠外肠内营养学会、亚洲肠外肠内营养学会及拉丁美洲肠外肠内营养学会组成工作组,探讨统一营养不良的诊断标准,经多方努力,终于达成一致意见,形成了营养不良的GLIM标准,并对外发布。GLIM标准包括3个表型标准(非自主体重丢失、低BMI及肌肉减少)和2个病因标准(摄食减少或消化吸收障碍,炎症或疾病负担),具备1个表型标准和1个病因标准即可以诊断营养不良。作为一个新的营养不良诊断标准,GLIM面临四个挑战(1)GLIM标准本身切点值,(2)GLIM与现有营养不良筛查、评估工具的比较,(3)GLIM对临床结局及预后预测及(4)GLIM不同标准内部之间的一致性。本文提出量化GLIM建议。[营养学报,2020,42(3):209-214]

Diagnostic criteria for malnutrition remain unclear because of a fundamental lack of consensus definition of malnutrition. In 2015, in an ESPEN consensus statement paper, malnutrition was defined as the insufficient intake of energy and macronutrients, namely protein-energy malnutrition(PEM). The updated definition offered the foundation for rebuilding a new diagnostic criterion for malnutrition. As a result, the Global Leadership Initiative on Malnutrition(GLIM) was born. The GLIM working group consisted of experts from ASPEN, ESPEN, PENSA, and FELANPE. In 2016, the GLIM working group proposed and published a consensus scheme for diagnosing malnutrition. The GLIM criteria include three phenotypic criteria(non-volitional weight loss, low BMI and reduced muscle mass) and two etiological criteria(reduced food intake or assimilation and disease burden/inflammation). It is recommended to diagnose malnutrition when at least one phenotypic criterion and one etiologic criterion is in presence. As a newly proposed diagnostic criteria, the GLIM criteria is still facing some challenges, including(1) the cut-off point for GLIM criteria,(2) how it compares with the existing tool for malnutrition screening and nutritional assessment,(3) how it predicts the clinical outcomes and prognosis, and(4) the homogeneity among GLIM criteria. In the present paper, the authors proposed some suggestions for scoring the GLIM criteria.[ACTA NUTRIMENTA SINICA, 2020,42(3):209-214]